Outline

Objective

Treatment options for geriatric patients with intracerebral hemorrhages are limited. In many cases, no surgical treatment is applied because of the poor prognosis of this patient group. Also, often only minimally invasive procedures such as placement of an external ventricular catheter are favored. However, other procedures such as an endoscopic 3rd ventriculostomy could reduce the risk of ventriculitis and long-term dependence on implant material. Here we present our series of patients of more than 70 yrs of age who received an endoscopic 3rd ventriculostomy for the treatment of acute hydrocephalus caused by cerebellar or intraventricular hemorrhage.

Methods

From 8/1997 to 10/2003, 11 endoscopic procedures were performed by the authors for hemorrhage related hydrocephalus in patients with more than 70 yrs of age. All patients were prospectively followed. The pathology of the patients (4 male; 7 female patients; mean age 73 years [range 70 to 78 years]) consisted of 2 supraventricular hemorrhages and 9 cerebellar hemorrhages with intraventricular component. Nine patients suffered from a hypertensive hemorrhage, 2 from hemorrhage in a cerebellar infarction. All presented with impaired consciousness with 8 being comatose. On CT, all patients harbored occlusive hydrocephalus.

Results

A 3rd ventriculostomy was performed in all patients. The intraventricular hematoma was partially removed endoscopically in 3 cases. There was no procedure related mortality. There was no recurrence of an intraventricular hemorrhage within their hospital stay and no postsurgical infection. After surgery, the ventricular size decreased in 9 cases (82%). Four patients improved clinically immediately after the procedures (36%), 3 remained unchanged (28%) and 4 further deteriorated (36%). The latter died from their hemorrhage within their hospital stay (36%).

Conclusions

In all, endoscopic ventriculostomy represents a safe and successful treatment option in hemorrhage related hydrocephalus in geriatric patients with similar results as an external drainage but less risk of infection. Particularly in cases in which the clinical symptoms are in a large part caused by the hydrocephalus, the endoscopic ventriculostomy appears to be the procedure of choice.